Ignite Creation Date:
2024-05-05 @ 11:19 AM
Last Modification Date:
2024-10-26 @ 9:01 AM
Study NCT ID:
NCT00000506
Status:
COMPLETED
Last Update Posted:
2013-11-26
First Post:
1999-10-27
Brief Title:
Cardiovascular System in Obesity Effect of Treatment
Sponsor:
National Heart Lung and Blood Institute NHLBI
Organization:
National Heart Lung and Blood Institute NHLBI
Study Overview
Official Title:
None
Status:
COMPLETED
Status Verified Date:
2000-01
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
To determine the long-term efficacy of the combination therapy of phentermine and fenfluramine in conjunction with diet exercise and behavior modification in the treatment of simple moderate obesity
Detailed Description:
BACKGROUND
Obesity is a problem of significant public health concern both in this and other western countries One reason is that it is a risk factor for cardiovascular disease most notably hypertension For example in the Framingham study it was found that relative body weight weight change during observation and skin fold thickness were related to existing blood pressure levels and to the subsequent rate of development of hypertension Additionally for previously normotensive individuals the risk of developing hypertension was proportional to the degree of overweight Obesity is also a major risk factor for type II diabetes mellitus On the other hand some overweight individuals are physically healthy but suffer from the psychosocial consequences of their condition so that losing weight would be desirable for them as well as for individuals more at risk for physical illness
Like essential hypertension obesity is not only a chronic condition for many individuals but it is also a heterogeneous condition with many underlying causes and interacting factors It is generally difficult to treat because it is a chronic problem success comes slowly and physicians in practice generally understand the condition rather poorly and do not manage it well Results from studies of caloric restriction behavior modification and medication have often been disappointing both to the subjects and their physicians In practice dropout rates from exercise programs as well as various dietary self-help programs have been relatively high
Similarly in clinical trials dropout rates have often been quite high Compounding the problem of weight management has been a rather universal negative bias on the part of physicians to prescribing anorexiant medications It was previously generally held that these agents were either only effective in the short term or not at all Additionally there has always been concern about the potential adverse effects of anorexiants as well as their potential for abuse Physicians who used appetite suppressants often prescribed them for only four to six weeks which was inappropriate in the management of a chronic condition
In several relatively short term clinical trials eg 16 weeks it has been shown that appetite control medications such as fenfluramine and phentermine were more effective than placebo in inducing weight loss It has been less clear from the trials performed heretofore how effective anorectic medications were when used as an adjunct to behavior modification and diet This aspect was addressed in the first two years of the clinical trial under consideration here
A second controversial issue concerned the duration of efficacy of anorexiant agents Originally it was felt that tolerance developed hence the recommendations for short courses of treatment A few long-term double-blind studies using anorexiants have since demonstrated that they exert beneficial effects for up to 24 weeks as evidenced by weight loss and maintenance of weight loss This was an important finding given as noted earlier the chronicity of the problem of obesity
The so-called stimulant anorexiants like phentermine are believed to act via central catecholamine mechanisms Side-effects include nervousness insomnia increased motor activity and cardiovascular disturbances such as tachycardia and elevation of blood pressure The latter effects led physicians to feel that their use in obese hypertensive patients was very limited Fenfluramine although chemically related to the stimulant anorexiants appears to act via serotonergic mechanisms It reportedly causes sedation occasionally diarrhea and few cardiovascular effects
DESIGN NARRATIVE
Double-blind fixed sample After a six-week single-blind placebo controlled diet and behavior modification period participants entered a parallel-group comparison of fenfluramine plus phentermine versus placebo In the third and fourth years of the study patients were randomly assigned to either continuous therapy or intermittent therapy The intermittent therapy group received the medication for three months from April through June and during the period between Thanksgiving and New Years day
The study completion date listed in this record was obtained from the QueryViewReport QVR System
Obesity is a problem of significant public health concern both in this and other western countries One reason is that it is a risk factor for cardiovascular disease most notably hypertension For example in the Framingham study it was found that relative body weight weight change during observation and skin fold thickness were related to existing blood pressure levels and to the subsequent rate of development of hypertension Additionally for previously normotensive individuals the risk of developing hypertension was proportional to the degree of overweight Obesity is also a major risk factor for type II diabetes mellitus On the other hand some overweight individuals are physically healthy but suffer from the psychosocial consequences of their condition so that losing weight would be desirable for them as well as for individuals more at risk for physical illness
Like essential hypertension obesity is not only a chronic condition for many individuals but it is also a heterogeneous condition with many underlying causes and interacting factors It is generally difficult to treat because it is a chronic problem success comes slowly and physicians in practice generally understand the condition rather poorly and do not manage it well Results from studies of caloric restriction behavior modification and medication have often been disappointing both to the subjects and their physicians In practice dropout rates from exercise programs as well as various dietary self-help programs have been relatively high
Similarly in clinical trials dropout rates have often been quite high Compounding the problem of weight management has been a rather universal negative bias on the part of physicians to prescribing anorexiant medications It was previously generally held that these agents were either only effective in the short term or not at all Additionally there has always been concern about the potential adverse effects of anorexiants as well as their potential for abuse Physicians who used appetite suppressants often prescribed them for only four to six weeks which was inappropriate in the management of a chronic condition
In several relatively short term clinical trials eg 16 weeks it has been shown that appetite control medications such as fenfluramine and phentermine were more effective than placebo in inducing weight loss It has been less clear from the trials performed heretofore how effective anorectic medications were when used as an adjunct to behavior modification and diet This aspect was addressed in the first two years of the clinical trial under consideration here
A second controversial issue concerned the duration of efficacy of anorexiant agents Originally it was felt that tolerance developed hence the recommendations for short courses of treatment A few long-term double-blind studies using anorexiants have since demonstrated that they exert beneficial effects for up to 24 weeks as evidenced by weight loss and maintenance of weight loss This was an important finding given as noted earlier the chronicity of the problem of obesity
The so-called stimulant anorexiants like phentermine are believed to act via central catecholamine mechanisms Side-effects include nervousness insomnia increased motor activity and cardiovascular disturbances such as tachycardia and elevation of blood pressure The latter effects led physicians to feel that their use in obese hypertensive patients was very limited Fenfluramine although chemically related to the stimulant anorexiants appears to act via serotonergic mechanisms It reportedly causes sedation occasionally diarrhea and few cardiovascular effects
DESIGN NARRATIVE
Double-blind fixed sample After a six-week single-blind placebo controlled diet and behavior modification period participants entered a parallel-group comparison of fenfluramine plus phentermine versus placebo In the third and fourth years of the study patients were randomly assigned to either continuous therapy or intermittent therapy The intermittent therapy group received the medication for three months from April through June and during the period between Thanksgiving and New Years day
The study completion date listed in this record was obtained from the QueryViewReport QVR System
Study Oversight
Has Oversight DMC:
Is a FDA Regulated Drug?:
Is a FDA Regulated Device?:
Is an Unapproved Device?:
Is a PPSD?:
Is a US Export?:
Is an FDA AA801 Violation?:
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| R01HL029188-04 | NIH | None | httpsreporternihgovquickSearchR01HL029188-04 |